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Standing on the shoulders of giants

Wilson Greatbatch sadly passed away on September 27, 2011. Unknown to many people, he is hailed as the inventor of the practical implanted pacemaker which, in 1983, was named by the National Society of Professional Engineers as one of the ten great engineering contributions made to society in the past 50 years.

Wilson Greatbatch

This is not surprising. It is estimated that worldwide three million patients have been fitted with a pacemaker, with over 600,000 more being fitted each year. The growing global market for pacemakers is worth over $3bn and has spawned a number of international businesses such as Medtronic and St Jude Medical. As we look back at the history of the pacemaker’s development, and glimpse into its future, we realise that we are standing on the shoulders of giants.

A pacemaker is an active implanted device that is used to treat conditions where the heart beats too slowly (brachycardia). By providing electrical stimulation, it ensures that the heart paces at the correct rate and is often the only and preferred method of treatment.

The remarkable story of the pacemaker really begins in Stockholm when, on October 8, 1958, Arne Larsson became the first person to have a pacemaker system implanted. His wife Else-Marie refused to believe that there was no cure for her husband – having heard of animal trials in cardiac pacing she persuaded Åke Senning and Rune Elmqvist to carry out the procedure on Arne. Åke was a surgeon at the Department of Thoracic Surgery, Karolinska Hospital, and Rune Elmqvist was an engineer at Elema-Schönander, a medical electronics firm. Rune constructed the first device in his kitchen and it lasted for three hours after implantation. The following day, a second device was implanted with more success. These devices were powered by nickel-cadmium (NiCad) cells, which were recharged by an inductive coil. Arne passed away from an unrelated condition in 2001, aged 86, having had 26 different pacemakers fitted in his lifetime – he outlived his surgeon Åke and the inventor Rune.

In 1956, across the other side of the world, recent Electrical Engineering graduate Wilson Greatbatch was working for Buffalo University on a device to measure heart rhythms. He realized that electrical impulses might be used to stimulate a failing heart and set about miniaturizing a device that was then implanted in a dog. In 1958, Wilson left his job and set up in his garden shed with $2,000 of his savings. Collaborating with William Hardwick at the Buffalo Veterans’ Affairs Hospital, in 1960 a device was implanted in a 77 year old man who subsequently survived for 18 months. Within a year, nine more patients had received devices including two children. The pacemakers were manufactured by Medtronic under license and, unlike the Swedish device, the Wilson Greatbatch pacemaker used primary (non-rechargeable) mercury cells, which had a limited life. Perhaps the greatest breakthrough that Wilson made was to recognize the potential of new lithium-iodine battery technology which promised a higher energy density and lower self-discharge characteristics. Introduced into pacemakers in 1971, the new battery technology offered implanted life times of over ten years.

Greatbatch Inc remains a leading supplier of batteries and pacemaker technology to this day, and the development of the pacemaker has also prompted further innovations in materials, signal processing, communications and electronics. Other implanted devices, such as the Implantable Cardiac Defibrillator (ICD), take their inspiration and heritage from pacemakers. However, there is much yet to do in implanted device innovation, and especially regarding miniaturization, longer battery life, increased functionality and less invasive procedures.

From the first pacemakers – invented in garden sheds and constructed in kitchens – a whole industry was spawned which changed literally millions of lives. As engineers we are inspired by the likes of Wilson Greatbatch and Rune Elmqvist and we marvel at brave patient pioneers such as Arne Larsson. It is clear that innovation thrives where there is an urgent need and where clinical, scientific and engineering experts can work together. It’s why we are drawn to the medical devices industry although most of us mortals merely get to stand on the shoulders of giants. Wilson Greatbatch we salute you – may you rest in peace.

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